A Systematic Review of Racial and Ethnic Disparities in Maternal Health Outcomes among Asians/Pacific Islanders

Abstract

Efforts to improve women’s health and to reduce maternal mortality worldwide have led to a notable reduction in the global maternal mortality ratio (MMR) over the past two decades. However, it is clear that maternal health outcomes are not equitable, especially when analyzing the scope of maternal health disparities across “developed” and “underdeveloped” nations. This study evaluates recent MMR scholarship with a particular focus on the racial and ethnic divisions that impact on maternal health outcomes. The study contributes to MMR research by analyzing the racial and ethnic disparities that exist in the US, especially among Asian and Pacific Islander (API) subgroups. The study applies exclusionary criteria to 710 articles and subsequently identified various maternal health issues that disproportionately affect API women living in the US. In applying PRISMA review guidelines, the study produced 22 peer-reviewed articles that met inclusionary and exclusionary criteria for this review. The data analysis identified several maternal health foci: obstetric outcomes, environmental exposure, obstetric care and quality measures, and pregnancy-related measures. Only eight of the 22 reviewed studies disaggregated API populations by focusing on specific subgroups of APIs, which signals a need to re-conceptualize marginalized API communities’ inclusion in health care systems, to promote their equitable access to care, and to dissolve health disparities among racial and ethnic divides. Several short- and long-term initiatives are recommended to develop and implement targeted health interventions for API groups, and thus provide the groundwork for future empirically driven research among specific API subgroups in the US.

Increased maternal morbidity and mortality among Asian American and Pacific Islander women in the military health system

“…4 Even though the population of Asian Pacific Islanders (APIs) continues to be one of the fastest growing racial groups in the United States, they are often excluded from studies looking at maternal outcomes. 6 , 7 Studies that have included API as a separate race showed that women who identify as API have the highest rate of maternal morbidity, including higher rates of PPH, acute end-organ damage, and mortality during hospitalization for delivery. 7 This difference in outcomes persists although APIs live in areas of higher socioeconomic status and are more likely to have private insurance.…”

“… 7 This difference in outcomes persists although APIs live in areas of higher socioeconomic status and are more likely to have private insurance. 6 …”